Fruit and Vegetable Intake and Mortality in Adults undergoing Maintenance Hemodialysis
- PMID: 31738182
- PMCID: PMC6390927
- DOI: 10.2215/CJN.08580718
Fruit and Vegetable Intake and Mortality in Adults undergoing Maintenance Hemodialysis
Abstract
Background and objectives: Higher fruit and vegetable intake is associated with lower cardiovascular and all-cause mortality in the general population. It is unclear whether this association occurs in patients on hemodialysis, in whom high fruit and vegetable intake is generally discouraged because of a potential risk of hyperkalemia. We aimed to evaluate the association between fruit and vegetable intake and mortality in hemodialysis.
Design, setting, participants, & measurements: Fruit and vegetable intake was ascertained by the Global Allergy and Asthma European Network food frequency questionnaire within the Dietary Intake, Death and Hospitalization in Adults with ESKD Treated with Hemodialysis study, a multinational cohort study of 9757 adults on hemodialysis, of whom 8078 (83%) had analyzable dietary data. Adjusted Cox regression analyses clustered by country were conducted to evaluate the association between tertiles of fruit and vegetable intake with all-cause, cardiovascular, and noncardiovascular mortality. Estimates were calculated as hazard ratios with 95% confidence intervals (95% CIs).
Results: During a median follow up of 2.7 years (18,586 person-years), there were 2082 deaths (954 cardiovascular). The median (interquartile range) number of servings of fruit and vegetables was 8 (4-14) per week; only 4% of the study population consumed at least four servings per day as recommended in the general population. Compared with the lowest tertile of servings per week (0-5.5, median 2), the adjusted hazard ratios for the middle (5.6-10, median 8) and highest (>10, median 17) tertiles were 0.90 (95% CI, 0.81 to 1.00) and 0.80 (95% CI, 0.71 to 0.91) for all-cause mortality, 0.88 (95% CI, 0.76 to 1.02) and 0.77 (95% CI, 0.66 to 0.91) for noncardiovascular mortality and 0.95 (95% CI, 0.81 to 1.11) and 0.84 (95% CI, 0.70 to 1.00) for cardiovascular mortality, respectively.
Conclusions: Fruit and vegetable intake in the hemodialysis population is low and a higher consumption is associated with lower all-cause and noncardiovascular death.
Keywords: Asthma; Cardiovascular Diseases; Diet; ESRD; Epidemiology and outcomes; Fruit; Hyperkalemia; Hypersensitivity; Proportional Hazards Models; Risk; Surveys and Questionnaires; Vegetables; clinical epidemiology; clinical nephrology; hemodialysis; mortality; mortality risk; nutrition; renal dialysis; risk factors; survival.
Copyright © 2019 by the American Society of Nephrology.
Figures
![None](https://cdn.statically.io/img/www.ncbi.nlm.nih.gov/pmc/articles/instance/6390927/bin/CJN.08580718absf1.gif)
![Figure 1.](https://cdn.statically.io/img/www.ncbi.nlm.nih.gov/pmc/articles/instance/6390927/bin/CJN.08580718f1.gif)
![Figure 2.](https://cdn.statically.io/img/www.ncbi.nlm.nih.gov/pmc/articles/instance/6390927/bin/CJN.08580718f2.gif)
![Figure 3.](https://cdn.statically.io/img/www.ncbi.nlm.nih.gov/pmc/articles/instance/6390927/bin/CJN.08580718f3.gif)
Comment in
-
Healthy Dietary Patterns But Not Fruit and Vegetables Keep Mortality Away: A Caution for Trials of Fruit and Vegetables in Dialysis Patients.Ther Apher Dial. 2020 Apr;24(2):236-237. doi: 10.1111/1744-9987.13423. Epub 2019 Aug 5. Ther Apher Dial. 2020. PMID: 31321891 No abstract available.
Similar articles
-
Fruit, vegetable, and legume intake and the risk of all-cause, cardiovascular, and cancer mortality: A prospective study.Clin Nutr. 2021 Jun;40(6):4316-4323. doi: 10.1016/j.clnu.2021.01.016. Epub 2021 Jan 27. Clin Nutr. 2021. PMID: 33581953
-
Dietary Patterns and Mortality in a Multinational Cohort of Adults Receiving Hemodialysis.Am J Kidney Dis. 2020 Mar;75(3):361-372. doi: 10.1053/j.ajkd.2019.05.028. Epub 2019 Sep 9. Am J Kidney Dis. 2020. PMID: 31515137
-
Fruit, vegetable, and legume intake, and cardiovascular disease and deaths in 18 countries (PURE): a prospective cohort study.Lancet. 2017 Nov 4;390(10107):2037-2049. doi: 10.1016/S0140-6736(17)32253-5. Epub 2017 Aug 29. Lancet. 2017. PMID: 28864331
-
Fruit and vegetable intake and the risk of cardiovascular disease, total cancer and all-cause mortality-a systematic review and dose-response meta-analysis of prospective studies.Int J Epidemiol. 2017 Jun 1;46(3):1029-1056. doi: 10.1093/ije/dyw319. Int J Epidemiol. 2017. PMID: 28338764 Free PMC article. Review.
-
Fruit and vegetable consumption and mortality from all causes, cardiovascular disease, and cancer: systematic review and dose-response meta-analysis of prospective cohort studies.BMJ. 2014 Jul 29;349:g4490. doi: 10.1136/bmj.g4490. BMJ. 2014. PMID: 25073782 Free PMC article. Review.
Cited by
-
Effect of banana intake on serum potassium level in patients undergoing maintenance hemodialysis: A randomized controlled trial.Int J Nurs Sci. 2024 Mar 14;11(2):197-204. doi: 10.1016/j.ijnss.2024.03.016. eCollection 2024 Apr. Int J Nurs Sci. 2024. PMID: 38707694 Free PMC article.
-
Re-Thinking Hyperkalaemia Management in Chronic Kidney Disease-Beyond Food Tables and Nutrition Myths: An Evidence-Based Practice Review.Nutrients. 2023 Dec 19;16(1):3. doi: 10.3390/nu16010003. Nutrients. 2023. PMID: 38201833 Free PMC article. Review.
-
Relationship between dietary fiber and all-cause mortality, cardiovascular mortality, and cardiovascular disease in patients with chronic kidney disease: a systematic review and meta-analysis.J Nephrol. 2024 Jan;37(1):77-93. doi: 10.1007/s40620-023-01808-4. Epub 2024 Jan 2. J Nephrol. 2024. PMID: 38165561 Free PMC article.
-
Overview of research progress on the association of dietary potassium intake with serum potassium and survival in hemodialysis patients, does dietary potassium restriction really benefit hemodialysis patients?Front Endocrinol (Lausanne). 2023 Nov 29;14:1285929. doi: 10.3389/fendo.2023.1285929. eCollection 2023. Front Endocrinol (Lausanne). 2023. PMID: 38093955 Free PMC article. Review.
-
The association between plant and animal protein intake and quality of life in patients undergoing hemodialysis.Front Nutr. 2023 Sep 19;10:1219976. doi: 10.3389/fnut.2023.1219976. eCollection 2023. Front Nutr. 2023. PMID: 37794969 Free PMC article.
References
-
- US Renal Data System (USRDS) : USRDS 2017 Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States, Bethesda, MD, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, 2017
-
- de Jager DJ, Grootendorst DC, Jager KJ, van Dijk PC, Tomas LM, Ansell D, Collart F, Finne P, Heaf JG, De Meester J, Wetzels JF, Rosendaal FR, Dekker FW: Cardiovascular and noncardiovascular mortality among patients starting dialysis. JAMA 302: 1782–1789, 2009 - PubMed
-
- Chertow GM, Block GA, Correa-Rotter R, Drüeke TB, Floege J, Goodman WG, Herzog CA, Kubo Y, London GM, Mahaffey KW, Mix TC, Moe SM, Trotman ML, Wheeler DC, Parfrey PS; EVOLVE Trial Investigators : Effect of cinacalcet on cardiovascular disease in patients undergoing dialysis. N Engl J Med 367: 2482–2494, 2012 - PubMed
-
- Cooper BA, Branley P, Bulfone L, Collins JF, Craig JC, Fraenkel MB, Harris A, Johnson DW, Kesselhut J, Li JJ, Luxton G, Pilmore A, Tiller DJ, Harris DC, Pollock CA; IDEAL Study : A randomized, controlled trial of early versus late initiation of dialysis. N Engl J Med 363: 609–619, 2010 - PubMed
-
- Eknoyan G, Beck GJ, Cheung AK, Daugirdas JT, Greene T, Kusek JW, Allon M, Bailey J, Delmez JA, Depner TA, Dwyer JT, Levey AS, Levin NW, Milford E, Ornt DB, Rocco MV, Schulman G, Schwab SJ, Teehan BP, Toto R; Hemodialysis (HEMO) Study Group : Effect of dialysis dose and membrane flux in maintenance hemodialysis. N Engl J Med 347: 2010–2019, 2002 - PubMed
Publication types
MeSH terms
LinkOut - more resources
Full Text Sources
Medical